Mental health: “Care is everybody’s right, but a privilege for only a few”

However, as in many countries around the world, accessing professional and well-resourced mental health support in Liberia remains a challenge for people in need.

At a Médecins Sans Frontières / Doctors Without Borders (MSF) healthcare centre in Monrovia, a 17-year-old arrives in chains. He is accompanied by his family, but he does not talk and his relatives seem to be ashamed of him. 

In the waiting room, many people are looking at them, but no one is surprised by the scene. Like many others before, this teenager has been confined and shackled with the family really struggling to respond to his needs without proper support.

After an initial assessment, it’s clear that the young man needs mental healthcare. His family have brought him to our clinic because they have heard that the team here might be able to help.

MSF is one of the few NGOs currently supporting mental health in Liberia. There are just a few clinics with the capacity and resources to treat mental illness in the whole country. 

Many people travel long distances to seek help in the facilities we support. The needs are extremely high, but as in many countries, they are still underestimated and under-prioritised. 

A worldwide problem

Liberia – one of the ten poorest countries in the world – is an example of what happens with mental health services worldwide. 

Globally, only two percent of government health budgets are designated for psychiatric care. Nowhere in the world does mental health enjoy parity with physical health in terms of budget allocation. 

As a consequence, in many places, there are few specialist mental health professionals and no medications to treat people who need psychiatric care. 

For example, according to the World Health Organization, worldwide, 71 percent of people with psychosis do not receive appropriate treatment. The needs are overlooked, and services are sadly inadequate.

However, this problem is not restricted to very low-income countries: more than two-thirds of countries do not cover mental health services in national health insurance schemes. This means that even in places where there are available resources, frequently they are only available to the privileged and are perceived as an unnecessary luxury. An expression of class. 

Mental health care is complex and can require multiple and simultaneous interventions in order to be effective. 

A person might need talking therapy and psychiatric medication, for example. Sometimes the treatment needed is long-term. It is an investment. When this care isn’t available, it sends a false message: a person with a psychiatric condition is seen as beyond help, unproductive and not a worthy investment.

Stigma 

Stigma about mental health conditions is a virus: powerful, invisible, and contagious. It can cause serious harm for people who live with these conditions, including loneliness and low self-worth.

As a psychologist, I’ve come across people who are homeless or unemployed not because their condition means they would never be able to work, but because of the stigma which drowns them in social exclusion. 

In so many places, people with psychiatric conditions are treated as the waste of society, the same feeling that pushes people into mental ill-health. 

Without the right treatment and support, people living with these disorders can be more vulnerable to serious human rights violations. Sexual violence and social exclusion are just some examples. Often, they draw limited attention: thinking about adequate and accessible care for them seems a utopia. 

MSF’s work in Liberia provides a crucial lesson: a major barrier to mental health care is the lack of understanding and awareness. If stigma is a virus, then like other diseases, this virus must be eradicated. 

One effective cure for stigma is raising awareness of mental health at all levels: among communities, healthcare service providers and governments. 

We have a strong and highly committed team who dedicate their lives to providing effective care and who recognise the dignity of the most vulnerable. 

Working with them has shown me that despite the challenges here and worldwide, Liberia is also an example of the hope needed to improve things for people who need psychiatric care.